HB 6537 Summary

• Lowers the employee threshold for public employers to receive claims utilization and cost information from 100 to 50 employees in medical benefit plans.

• Requires medical benefit plans to compile and provide data in electronic, spreadsheet-compatible format including census information, incurred and paid claims data, prescription drug information, and administrative fees on an annual basis and upon request (up to 4 times per year).

• Changes the relevant data period from 36 months to 24 months, with information no more than 60 days (reduced from 120 days) before compilation date.

• Adds definition of "specialty prescription drug" as drugs requiring special administration, delivery, storage, or intensive monitoring for rare, complex, or chronic conditions.

• Modifies terminology throughout from "commissioner" to "director" and updates references to department structure while maintaining HIPAA compliance for de-identified health information.